Physical activity and circulating inflammatory markers and cytokines during pregnancy: A population-based cohort study.

INTRODUCTION: Physical activity (PA) during pregnancy has numerous benefits, which may be mediated via effects on the immune system. However, supportive evidence is inconsistent and is mainly from studies in high-risk groups. We estimated the effect of PA during pregnancy on systemic inflammatory markers and cytokines in mothers recruited in the Barwon infant study. MATERIAL AND METHODS: The Barwon infant study is a prebirth cohort of 1064 mothers recruited in the Barwon Region of Victoria, Australia. Participants reported their previous week's PA at their 28-week antenatal appointment using the International PA Questionnaire. Women were grouped into low, moderate, and high PA categories based on daily duration and weekly frequency of walking, moderate- or vigorous-intensity PA. Women reporting moderate levels of PA, consistent with current recommendations, served as the comparison group. Markers of systemic inflammation, high-sensitivity C-reactive protein (hsCRP), glycoprotein acetyls (GlycA), and 17 cytokines were measured at 28 weeks gestation and log transformed as appropriate. Regression analyses adjusted for maternal smoking, gestational diabetes mellitus, prepregnancy BMI, and household size were performed. RESULTS: Compared to women in the moderate group (n = 371, 42%), women reporting low PA (n = 436, 50%) had 10.1% higher hsCRP (95% CI (3.7% to 16.6%), p < 0.01) while women in high PA (n = 76, 9%) had a 14% higher hsCRP (95% CI (3.1% to 24.8%), p = 0.01). Women in the high PA category had higher interleukin (IL)-4 (q = 0.03) and IL-9 (q = 0.03) levels compared to those in moderate category. Each vigorous MET minute/week was associated with lower GlycA (ß = -0.004, 95% CI (-0.044 to 0.035); p = 0.03). CONCLUSIONS: Low and high PA are each associated with higher hsCRP than moderate PA, suggesting that undertaking the recommended moderate PA during pregnancy decreases systemic inflammation. High PA affects T cell-associated cytokines during pregnancy. Evidence from our study suggests that PA can modulate the immune responses during pregnancy. Studies are now required to assess whether PA during pregnancy impacts maternal and infant clinical outcomes by modifying inflammatory responses.

Are physical activity and sleep associated with emotional self-regulation in toddlers? a cross-sectional study.

BACKGROUND: Toddlerhood (2-3 years) is a crucial period for the development of physical activity, sleep, and emotional self-regulation skills. Although there is growing evidence of positive associations between physical activity, sleep, and emotional self-regulation in school-aged children, the associations in toddlers remain unclear. Thus, this study aimed to examine the association between physical activity, sleep, and emotional self-regulation in toddlers. METHODS: Baseline data from 1350 toddlers (2.2 ± 0.33 year) from the Let's Grow randomised controlled trial were used. Toddlers' total physical activity (TPA) and moderate- to vigorous-intensity physical activity (MVPA) were assessed via 4 + days of accelerometry and a 3-item parent-report scale. Parent-reported total sleep quantity was calculated using the sum of average night-time sleep and daytime nap durations. Sleep behaviour data including bedtime routine, bedtime resistance, sleep onset-delay, sleep duration, and night waking were collected using relevant subsections from the Child Sleep Habits Questionnaire (CSHQ) and Brief Infant Sleep Questionnaire revised (BISQ-R). A 4-item parent-report scale adapted from the Fast Track Project Child Behaviour Questionnaire was used to assess toddlers' emotional self-regulation. Linear regression models were used, adjusting for child age, sex, and parental education. RESULTS: Accelerometer-derived TPA, MVPA and parent-reported TPA were not associated with emotional self-regulation. Higher parent-reported MVPA (B = -0.01 CI95 -0.03, -0.003) was associated with poorer emotional self-regulation. Higher sleep duration was associated with better emotional self-regulation (B = 0.06 CI95 0.04, 0.08). The five sleep behaviours assessed were also positively associated with emotional self-regulation (all p < 0.01), with fewer problem sleep behaviours being associated with better emotional self-regulation. CONCLUSIONS: This cross-sectional study suggests that sleep may be important for emotional self-regulation in toddlers, but the role of physical activity remains unclear. These findings suggest that interventions targeting sleep duration and sleep behaviours during the early toddler years may benefit the positive development of emotional self-regulation skills in this population.

Cross-sectional and prospective associations between behavioural patterns and adiposity in school-aged children.

OBJECTIVE: Behavioural patterns are important in understanding the synergistic effect of multiple health behaviours on childhood adiposity. Most previous evidence assessing associations between patterns and adiposity were cross-sectional and investigated two or three behaviour domains within patterns. This study aimed to identify behavioural patterns comprising four behaviour domains and investigate associations with adiposity risk in children. DESIGN: Parent-report and accelerometry data were used to capture daily dietary, physical activity, sedentary behaviour and sleep data. Variables were standardised and included in the latent profile analysis to derive behavioural patterns. Trained researchers measured children's height, weight and waist circumference using standardised protocols. Associations of patterns and adiposity measures were tested using multiple linear regression. SETTING: Melbourne, Australia. PARTICIPANTS: A total of 337 children followed up at 6-8 years (T2) and 9-11 years (T3). RESULTS: Three patterns derived at 6-8 years were broadly identified to be healthy, unhealthy and mixed patterns. Patterns at 9-11 years were dissimilar except for the unhealthy pattern. Individual behaviours characterising the patterns varied over time. No significant cross-sectional or prospective associations were observed with adiposity at both time points; however, children displaying the unhealthy pattern had higher adiposity measures than other patterns. CONCLUSION: Three non-identical patterns were identified at 6-8 and 9-11 years. The individual behaviours that characterised patterns (dominant behaviours) at both ages are possible drivers of the patterns obtained and could explain the lack of associations with adiposity. Identifying individual behaviour pattern drivers and strategic intervention are key to maintain and prevent the decline of healthy patterns.

Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors.

BACKGROUND: Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors. METHODS: Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment. RESULTS: Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality. CONCLUSIONS: Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.

"Everything kind of revolves around technology": a qualitative exploration of families' screen use experiences, and intervention suggestions.

BACKGROUND: Managing children's screen time is challenging for most families. Interventions have had limited success in reducing screen time, potentially due to a lack of understanding of the experiences, needs and recommendations of families. This study aimed to 1) understand the screen time experiences of families, particularly during COVID-19 lockdowns; and 2) explore parent and child suggestions for the design, components, and content of a screen time management program. METHODS: Parents and children from 30 families living in Victoria, Australia completed a semi-structured interview (63 interviews) via Zoom in October-November 2021. Parents were maged 40.8 (± 8.9) years and predominantly female (90%). Children were maged 11.4 (± 2.4) years and 47% female. The interviews were audio recorded, transcribed verbatim and analysed using inductive thematic analysis combined with a summative content analysis approach. RESULTS: Three themes under Aim 1 emerged. Theme 1) 'Screen time management experiences and practices', including rules and strategies, challenges, and the impact of COVID-19 lockdowns. Theme 2) 'Impact of screens on family interaction and communication' including conflicts within the family, reduced face-to-face interactions, and negative impact on child's behaviour and wellbeing. Theme 3) 'Benefits of increased screen time due to COVID-19 lockdowns' including continuation of social interactions, extracurricular activities, improved technology skills and using screens as a 'babysitter'. Findings from Aim 2 suggest that families want a screen time management program delivered online to parents and children, which includes static and interactive content that incorporates health information, alternative activities, cyber-safety information, tips for goal setting and rewards, screen monitoring tools, links to reputable information, and parent social connections. Reminders via text message or through the online platform would help maintain engagement in the program. CONCLUSIONS: Families are experiencing challenges in managing the complex balance between the increased need for screens and the impact it has on the family. These findings provide valuable parent and child insights to assist in developing screen time management programs that are created with an understanding of the needs and challenges of families.

Volume and accumulation patterns of physical activity and sedentary time: longitudinal changes and tracking from early to late childhood.

BACKGROUND: Physical activity (PA) decreases and sedentary time (SED) increases across childhood, with both behaviours tracking. However, no studies have examined how accumulation patterns of PA and SED (i.e., prolonged bouts, frequency of breaks in sedentary time) change and track over time. The aim of this study was to investigate longitudinal changes in and tracking of total volume and accumulation patterns of SED, light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) among boys and girls. METHODS: In 2008/09 (T1), children in HAPPY (3-5y; n = 758) in Melbourne, Australia wore ActiGraph GT1M accelerometers to objectively assess SED, LPA, MPA and VPA. This was repeated at age 6-8y (T2; n = 473) and 9-11y (T3; n = 478). Ten pattern variables were computed: bouts of ≥ 5-, ≥ 10-, ≥ 15- and ≥ 20-min for SED, ≥ 1- and ≥ 5-min for LPA, ≥ 1-min for MPA, ≥ 1- and ≥ 5-min for VPA, and breaks in SED (interruptions of > 25 counts 15 s- 1). Longitudinal mixed models examined changes from T1-3, controlling for T1 age. Generalized estimating equations assessed tracking over the three time points, controlling for T1 age and time between measurements. Analyses were stratified by sex. RESULTS: Total volume and bouts of SED and SED breaks increased, while total volume and bouts of LPA decreased for both sexes. There was a small decrease in total volume of MPA for girls, but time spent in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys only. All volume and pattern variables tracked moderately for boys, except for all SED bouts ≥ 15-min, LPA bouts ≥ 5-min and MPA bouts ≥ 1-min (which tracked weakly). For girls, total SED and SED bouts ≥ 1-min tracked strongly, total volume of LPA, MPA and VPA, ≥ 5- and ≥ 10-min SED bouts, and ≥ 1-min LPA and MPA bouts tracked moderately, and SED breaks, all SED bouts ≥ 15 min, LPA bouts ≥ 5 min and all VPA bouts tracked weakly. CONCLUSIONS: Patterns of SED and PA change from early to late childhood; with the exception of SED breaks and VPA, changes were detrimental. Total volumes and short bouts tended to track more strongly than longer bouts. Interventions to prevent declines in PA and increases in SED are important from early in life.

Long-term outcomes (2 and 3.5 years post-intervention) of the INFANT early childhood intervention to improve health behaviors and reduce obesity: cluster randomised controlled trial follow-up.

BACKGROUND: The few health behavior interventions commencing in infancy have shown promising effects. Greater insight into their longer-term benefits is required. This study aimed to assess post-intervention effects of the Melbourne INFANT Program to child age 5y on diet, movement and adiposity. METHODS: Two and 3.5y post-intervention follow-up (2011-13; analyses completed 2019) of participants retained in the Melbourne INFANT Program at its conclusion (child age ~ 19 m; 2008-10) was conducted. The Melbourne INFANT Program is a 15-month, six session program delivered within first-time parent groups in Melbourne, Australia, between child age 4-19 m. It involves strategies to help parents promote healthy diet, physical activity and reduced sedentary behavior in their infants. No intervention was delivered during the follow-up period reported in this paper. At all time points height, weight and waist circumference were measured by researchers, children wore Actigraph and activPAL accelerometers for 8-days, mothers reported children's television viewing and use of health services. Children's dietary intake was reported by mothers in three unscheduled telephone-administered 24-h recalls. RESULTS: Of those retained at program conclusion (child age 18 m, n = 480; 89%), 361 families (75% retention) participated in the first follow-up (2y post-intervention; age 3.6y) and 337 (70% retention) in the second follow-up (3.5y post-intervention; age 5y). At 3.6y children in the intervention group had higher fruit (adjusted mean difference [MD] = 25.34 g; CI95:1.68,48.99), vegetable (MD = 19.41; CI95:3.15,35.67) and water intake (MD = 113.33; CI95:40.42,186.25), than controls. At 5y they consumed less non-core drinks (MD = -27.60; CI95:-54.58,-0.62). Sweet snack intake was lower for intervention children at both 3.6y (MD = -5.70; CI95:-9.75,-1.65) and 5y (MD = -6.84; CI95:-12.47,-1.21). Intervention group children viewed approximately 10 min/day less television than controls at both follow-ups, although the confidence intervals spanned zero (MD = -9.63; CI95:-30.79,11.53; MD = -11.34; CI95:-25.02,2.34, respectively). There was no evidence for effect on zBMI, waist circumference z-score or physical activity. CONCLUSIONS: The impact of this low-dose intervention delivered during infancy was still evident up to school commencement age for several targeted health behaviors but not adiposity. Some of these effects were only observed after the conclusion of the intervention, demonstrating the importance of long-term follow-up of interventions delivered during early childhood. TRIAL REGISTRATION: ISRCTN Register ISRCTN81847050 , registered 7th November 2007.

Differences Between Mothers and Fathers of Young Children in Their Use of the Internet to Support Healthy Family Lifestyle Behaviors: Cross-Sectional Study.

BACKGROUND: In early life, both mothers and fathers are important influences on their children's diet, active play, and obesity risk. Parents are increasingly relying on the internet and social media as a source of information on all aspects of parenting. However, little is known about the use of Web-based sources of information relevant to family lifestyle behaviors and, in particular, differences between mothers' and fathers' use and sociodemographic predictors. OBJECTIVE: The objective of this study was to examine if mothers and fathers differ in their use of the internet for information on their own health and their child's health, feeding, and playing and to examine sociodemographic predictors of the use of the internet for information on these topics. METHODS: We conducted a secondary analysis on data collected from mothers (n=297) and fathers (n=207) participating in the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) when their children were 36 months of age. The main outcome variables were the use of the internet for information gathering for parents' own health and child health, feeding, and playing. Binary logistic regression was used to examine the sociodemographic predictors of outcomes. RESULTS: Compared with fathers (n=296), a higher proportion of mothers (n=198) used the internet for information on their own health (230, 78.5% vs 93, 46.5%), child health (226, 77.1% vs 84, 42.4%), child feeding (136, 46.3% vs 35, 17.5%), and child play (123, 42.1% vs 28, 14.0%) and intended to use Facebook to connect with other parents (200, 74.9% vs 43, 30.5%). Despite the high use of the internet to support family health behaviors, only 15.9% (47/296) of mothers reported consulting health practitioners for advice and help for their own or their child's weight, diet, or physical activity. Sociodemographic predictors of internet use differed between mothers and fathers and explained only a small proportion of the variance in internet use to support healthy family lifestyle behaviors. CONCLUSIONS: Our findings support the use of the internet and Facebook as an important potential avenue for reaching mothers with information relevant to their own health, child health, child diet, and active play. However, further research is required to understand the best avenues for engaging fathers with information on healthy family lifestyle behaviors to support this important role in their child's life. TRIAL REGISTRATION: ISRCTN Registry ISRCTN81847050; http://www.isrctn.com/ISRCTN81847050.

Associations between maternal concern about child's weight and related behaviours and maternal weight-related parenting practices: a cross-sectional study.

BACKGROUND: Parents influence their children's weight-related behaviours through their parenting practices, which are often a focal point of obesity prevention interventions. This study examined associations of maternal concern about their child's weight, dietary intake, physical activity, and media use with maternal food, physical activity, and media parenting practices. METHODS: Mothers (n = 310) reported their level of concern regarding their child's weight and related behaviours and their weight-related parenting practices when their child was 5 years of age as part of the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. We used linear regression analyses with estimation by generalized estimating equations to examine associations of maternal concern and maternal parenting practices. RESULTS: Slightly more than 60% of mothers reported at least one concern related to their children's weight or related behaviours. Excessive media use was the most commonly endorsed concern among mothers (45.2%). Compared to mothers who were unconcerned about their child's weight, mothers who were concerned about their child weighing too much reported higher levels of controlling feeding practices, i.e., restrictive feeding, lower levels of co-participation of physical activity, and higher levels of using media to control child behaviour. Mothers who were concerned their child weighed too little reported higher levels of controlling feeding practices, i.e., restrictive feeding, pressure to eat. Similarly, mothers who were concerned about their child's eating (eating too much or too little) reported higher levels of controlling feeding practices. Mothers who were concerned about their child using too much media reported higher levels of using media to regulate their child's behaviour and providing opportunities for their child to use media. CONCLUSION: Mothers who were concerned about their child's weight, dietary intake, physical activity and media use reported higher levels of controlling parenting practices, i.e., pressure to eat, and lower levels of health promoting parenting practices, i.e., co-participation in physical activity. Longitudinal research is needed to elucidate temporal order and specific mechanisms of these associations.

Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials.

AIM OR OBJECTIVE: To evaluate the effectiveness of behavioural interventions that report sedentary behaviour outcomes during early childhood. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with Full Text and EMBASE electronic databases were searched in March 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were: (1) published in a peer-reviewed English language journal; (2) sedentary behaviour outcomes reported; (3) randomised controlled trial (RCT) study design; and (4) participants were children with a mean age of ≤5.9 years and not yet attending primary/elementary school at postintervention. RESULTS: 31 studies were included in the systematic review and 17 studies in the meta-analysis. The overall mean difference in screen time outcomes between groups was -17.12 (95% CI -28.82 to -5.42) min/day with a significant overall intervention effect (Z=2.87, p=0.004). The overall mean difference in sedentary time between groups was -18.91 (95% CI -33.31 to -4.51) min/day with a significant overall intervention effect (Z=2.57, p=0.01). Subgroup analyses suggest that for screen time, interventions of ≥6 months duration and those conducted in a community-based setting are most effective. For sedentary time, interventions targeting physical activity (and reporting changes in sedentary time) are more effective than those directly targeting sedentary time. SUMMARY/CONCLUSIONS: Despite heterogeneity in study methods and results, overall interventions to reduce sedentary behaviour in early childhood show significant reductions, suggesting that this may be an opportune time to intervene. TRIAL REGISTRATION NUMBER: CRD42015017090.

Do the correlates of screen time and sedentary time differ in preschool children?

BACKGROUND: Preschool children can spend up to 12 h a day in sedentary time and few meet current recommendations for screen time. Little is known about ecological correlates that could be targeted to decrease specific versus total sedentary behaviour. This study examined whether the correlates of screen time and sedentary time differ in preschool boys and girls. METHODS: Parents participating in the HAPPY Study in 2008/09 in Melbourne, Australia reported their child's usual screen time and potential individual, social and physical environment correlates. Children wore ActiGraph GT1M accelerometers for eight days to objectively assess sedentary time (<100 counts.min-1). Multivariable linear regression analyses were performed, stratified by sex and controlling for child age, preschool/childcare attendance and clustering by centre of recruitment. Correlates significantly associated with screen time or sedentary time in individual models (p < 0.05) were included in final combined models. RESULTS: Children were sedentary for 301.1 (SD 34.1) minutes/day and spent 108.5 (SD 69.6) minutes/day in screen time. There were no sex differences in screen or sedentary time. In the final models, sleep duration was inversely associated with girls' sedentary time and boys' screen time. The only other consistent correlates for boys and girls were parental self-efficacy to limit screen time and screen time rules, which were inversely associated with screen time for both sexes. Parents reporting that they get bored watching their child play was inversely associated and maternal television viewing was positively associated with boys' screen time. Paternal age was positively associated with boys' sedentary time. Maternal ethnicity was inversely associated and paternal education, child preferences for sedentary behaviour, and parental concerns about child's physical activity and sedentary behaviour were positively associated with girls' screen time. CONCLUSIONS: The modifiable correlates of total sedentary and screen time identified in this study could be targeted in interventions to reduce these behaviours. With correlates differing for screen and sedentary time, and between boys and girls, interventions may also benefit from including behaviour- and sex-specific strategies.

Proportion of infants meeting the Australian 24-hour Movement Guidelines for the Early Years: data from the Melbourne InFANT Program.

BACKGROUND: Little information is available on the movement behaviours of infants, despite evidence that these are important for development. The release of new Australian 24-hour Movement Guidelines provides an opportunity to document the current state of movement behaviours in infants relative to these guidelines. The aim of this study was to report the prevalence of 4 month old Australian infants meeting the 24-hour Movement Guidelines, individually, and in combination, and to describe associations with individual characteristics. METHODS: Maternal report baseline data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program were used to determine prevalence of infants meeting physical activity (30 min of tummy time per day), sedentary behaviour (no more than 1 h at a time kept restrained; zero screen time), and sleep guidelines (14-17 h for 0-3 month olds or 12-16 h for 4-11 month olds). Prevalence of infants meeting combined guidelines was also described. The odds of meeting guidelines based on infant and family characteristics was determined. RESULTS: Data are reported for 455 infants with a mean age of 3.6 months (SD = 1.0). The proportion of infants meeting each of the guidelines was 29.7% for tummy time, 56.9% for kept restrained, 27.9% for screen time, 58.7% for sleep and 3.5% for the combined guidelines (i.e. meeting all four guidelines). A significantly higher proportion of girls than boys met the screen time guideline (32.5% versus 24.0%, p = 0.04) and the combined guidelines (5.7% versus 1.6%, p = 0.01). Few associations were observed between infant and family characteristics and proportion of infants meeting individual guidelines. CONCLUSIONS: Very few infants met all of the guidelines contained in the new Australian 24-hour Movement Guidelines suggesting there is much room for improvement in movement behaviours from early life. Fewer infants met the tummy time and screen time guidelines hence these appear to be the behaviours requiring most attention. Parents and others providing care to infants require support and strategies to assist them in adhering to the guidelines to ensure optimal health and development for the youngest in our population.

A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep.

BACKGROUND: In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. METHODS: The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines. RESULTS: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1-2 years) and preschoolers (3-5 years). CONCLUSIONS: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Prevalence of sedentary behavior in children under 2years: A systematic review.

Sedentary behavior has negative health outcomes, evident even in young children. Identifying the prevalence of sedentary behavior in children <2years is important for determining the necessity for intervention strategies. The aim of this systematic review was to determine the prevalence of sedentary behavior in children <2years. Medline, PsycINFO, SPORTDiscus, and Education Research Complete electronic databases were searched, as were reference lists of included articles and the authors' own collections. Inclusion criteria were: published in a peer-reviewed English language journal; mean age of children <2years; and a reported measure of the prevalence of sedentary behavior. Twenty-four studies met the inclusion criteria. Most studies used parent-reported screen time as the sedentary behavior measure; only one study reported time spent restrained (i.e., kept inactive) and no studies reported objectively assessed sedentary time. Estimates of young children's screen time ranged from 36.6 to 330.9min/day. The proportion of children meeting the zero screen time recommendation ranged from 2.3% to 83.0%. In conclusion, very little is known about sedentary behaviors other than screen time in this age group. Although highly variable, findings suggest that children are already engaging in high levels of screen time by age 2 and the majority exceed current recommendations.

Addressing the social determinants of inequities in physical activity and sedentary behaviours.

Participation in both physical activity and sedentary behaviours follow a social gradient, such that those who are more advantaged are more likely to be regularly physically active, less likely to be sedentary, and less likely to experience the adverse health outcomes associated with inactive lifestyles than their less advantaged peers. The aim of this paper is to provide, in a format that will support policymakers and practitioners, an overview of the current evidence base and highlight promising approaches for promoting physical activity and reducing sedentary behaviours equitably at each level of 'Fair Foundations: The VicHealth framework for health equity'. A rapid review was undertaken in February-April 2014. Electronic databases (Medline, PsychINFO, SportsDISCUS, CINAHL, Scopus, Web of Science, Cochrane Library, Global Health and Embase) were searched using a pre-defined search strategy and grey literature searches of websites of key relevant organizations were undertaken. The majority of included studies focussed on approaches targeting behaviour change at the individual level, with fewer focussing on daily living conditions or broader socioeconomic, political and cultural contexts. While many gaps in the evidence base remain, particularly in relation to reducing sedentary behaviour, promising approaches for promoting physical activity equitably across the three levels of the Fair Foundations framework include: community-wide approaches; support for local and state governments to develop policies and practices; neighbourhood designs (including parks) that are conducive to physical activity; investment in early childhood interventions; school programmes; peer- or group-based programmes; and targeted motivational, cognitive-behavioural, and/or mediated individual-level approaches.

Early childhood physical activity, sedentary behaviors and psychosocial well-being: a systematic review.

OBJECTIVES: Little is known about how health behaviors such as physical activity (PA) and sedentary behaviors (SB) may be associated with psychosocial well-being during the crucial early childhood period. The aim of this study was to undertake a systematic review of associations between PA, SB and psychosocial well-being during early childhood. METHODS: In February 2013, MEDLINE, PsycINFO, SPORTDiscus and Embase electronic databases were searched. Inclusion criteria were: 1. peer-reviewed publication since 1980 in English; 2. children aged birth-5 years; 3. PA or SB measured during early childhood; 4. an indicator of child psychosocial well-being; and 5. association between PA/SB and psychosocial well-being reported. Studies could be observational or interventions. Data were extracted by one author and entered into a standardized form in February and March 2013. RESULTS: 19 studies were identified: four examined PA, 13 examined SB and two examined PA and SB. No interventions met the inclusion criteria; all included studies were observational. In total, 21 indicators of psychosocial well-being were examined, 13 only once with the remaining eight reported in more than one study. Some dose-response evidence was identified suggesting that PA is positively, and SB inversely, associated with psychosocial well-being. CONCLUSIONS: Too few studies exist to draw conclusions regarding associations. Future high-quality cohort and intervention studies are warranted particularly investigating dose-response associations.

Association between physical activity and self-regulation in early childhood: A systematic review.

Physical activity and self-regulation are important predictors of pediatric overweight and obesity. Young children (0-5 years) with lower physical activity levels and poorer self-regulation skills are at greater risk for overweight. Despite growing evidence that the two constructs are interrelated, their association remains unclear in young children. This review systematically summarized associations between physical activity and self-regulation in early childhood and explored the directionality of associations. Searches were run in six electronic databases. Forty-seven papers met inclusion criteria. Only three studies investigated all three domains of self-regulation (behavioral, cognitive, and emotional). Overall, findings were inconclusive; studies reported weak to moderate positive associations (n = 17), inverse associations (n = 5), mixed associations (n = 15), null association (n = 2), and negative (n = 1) between physical activity and self-regulation. Compared with the emotional and cognitive domains, physical activity was most consistently positively associated with behavioral self-regulation. Only one study assessed bidirectional associations, reporting a positive association. The three studies that included global self-regulation showed contradicting findings. There is some evidence that physical activity dose and sex potentially confound these associations; however, further research is needed given the paucity of studies. This review highlights the need for more in-depth investigation of the complex association between physical activity and global self-regulation.

Prevalence of toddlers meeting 24-hour movement guidelines and associations with parental perceptions and practices.

OBJECTIVES: Whether toddlers (1-2 years) meet 24-hour Movement Guidelines and how parental practices and perceptions are related to compliance are uncertain. This study: a) estimated the proportion of toddlers meeting individual and combined movement guidelines; and b) examined associations between parental perceptions/practices and toddlers' compliance with movement guidelines. DESIGN: Cross-sectional study. METHODS: Australian parents self-reported their parenting practices/perceptions (routines, co-participation, restrictions, concerns, knowledge) and toddlers' movement behaviours in the baseline assessment of Let's Grow (n=1145), a randomised controlled trial. The World Health Organization's Guidelines on Physical Activity, Sedentary Behaviour, and Sleep for children under 5 years were used to estimate the prevalence of compliance with individual and combined movement guidelines. Logistic models assessed cross-sectional associations. RESULTS: The prevalence of meeting guidelines was 30.9% for screen time, 82.3% for sleep, 81.6% for physical activity, 20.1% for combined, and 2.1% meeting none. Parents' knowledge of the guidelines, fewer concerns and more favourable restrictions concerning movement behaviours were associated with greater compliance with individual and combined movement guidelines. Routines for screen time and for combined behaviours were associated with adherence to their respective guidelines. Less co-participation in screen time and more co-participation in physical activity were associated with greater compliance with the relevant guidelines. CONCLUSIONS: Given only 20% of toddlers met all guidelines, strategies early in life to establish healthy movement behaviours, especially screen time, are needed. Future studies could target the parental practices/perceptions identified in this study to support toddlers with optimal sleep and physical activity and reduced screen time.